The Ryan Republican Medicare Reforms: What They Are, What They’re Not, and What They Might Become | Health Reform Report
The Medicare proposal in U.S. Congressman Paul Ryan’s budget plan, Path to Prosperity, is superior to the status quo, or anything proposed by President Obama. However, it is somewhat vaguer – and might differ significantly – from the high standard for reform that Ryan set himself last year, in Roadmap for America’s Future.
Some of Ryan’s biggest fans did not initially appreciate the difference. The Wall Street Journal editorialized (incorrectly) that the Path to Prosperity “means that at age 65 you would be able to keep your same insurer, with the feds paying for that insurance instead of your employer.”
But that was a feature of last year’s Roadmap, not this month’s proposed budget. The Wall Street Journal corrected the record the next day, clarifying that “the subsidies will flow through Medicare, only to regulated insurers and government-approved plans. It does not go as far as Ryan’s previous ‘roadmap’ which offered direct cash vouchers for individuals who preferred to buy insurance themselves.”
The previous Roadmap contained a very precise Medicare “payment” (in Ryan’s words) of $11,000, to be adjusted for future inflation by a factor combining changes in the Consumer Price Index and changes in medical prices, for future Medicare beneficiaries who are now under 55 years of age. Path to Prosperity eliminates the payment in favor of the somewhat more vague “premium support.” Nor does it even report how it would calculate this premium support, beyond asserting that “wealthier beneficiaries would receive a lower subsidy” (p. 46).
Under the previous Roadmap, you could have taken the payment and used it to “to pay for one of the Medicare certified plans, or any other plan, such as those offered by former employers or available from the private market” (p. 51). In other words, you would have had the freedom to buy a Medicare Advantage plan, or to pay your employer for a retiree health plan, or buy an individual plan regulated by your state’s Insurance Commissioner.
Under the current proposal, we’d be forced to choose a plan from a federal “tightly regulated exchange.” This change is disconcerting for two reasons. First, “exchange” is Obamacare language. It makes little sense for Ryan and his colleagues to pledge to cut off funding for Obamacare’s state-based exchanges (which will provide the means whereby working Americans will lose our employer-based health benefits), while proposing to set up a new federal bureaucracy with the same name for Medicare beneficiaries. Second, people rightly associate an exchange with a limited choice of plans selected by a politically appointed board, offering benefits determined by bureaucrats’ whims.
Of course, the Wall Street Journal also notes that Ryan “moderated his ambitions” because “reforms of this order are so unusual,” and that Ryan’s Medicare would look a lot like Medicare Advantage. Ryan should have hired the Wall Street Journal‘s editorial board to write his proposal, because using the term Medicare Advantage instead of “exchange” puts the reform in an entirely more positive light.
Medicare Advantage is a popular alternative to traditional Medicare, whereby seniors can choose Medicare through a private plan, which does not have to pay providers according to the government’s Soviet-style fixed-price schedule. Obamacare will drive about a half of participating seniors out of the program, as I discussed in a study of the costs and benefits of Medicare Advantage.
Instead of jettisoning this popular program in favor of an Obamacare-style exchange, Republicans who wish to bring this valuable reform to fruition should combine the best features of Medicare Advantage with the best features of Medigap, another popular option used by Medicare seniors to supplement traditional Medicare. Such a reform would allow Medicare beneficiaries to use their Medicare “payments” (or whatever Ryan & Co. want to call them) to buy long-term, individual health insurance, which protects seniors from unanticipated premium hikes by guaranteed renewability, as more fully described in the study cited above.
Ryan and his Republican colleagues have made a very serious proposal to reform Medicare by allowing seniors more choices while protecting taxpayers. Anticipating political risks, they camouflaged their proposal in language that makes the benefits unnecessarily difficult to perceive. As they move it forward, I trust that they will advance it in a way that makes those benefits more clear to the American public.
John R. Graham is the director of health care studies at the Pacific Research Institute.
El presidente de Ecuador Rafael Correa acusó el jueves a la prensa local de ser parciales a la campaña del “No” opositor en la consulta convocada por el mandatario entre otros fines para reformar el sistema judicial.
A la vez el primer mandatario ecuatoriano acusó a la prensa en general de frenar los cambios en América Latina.
Correa hizo estas declaraciones durante el “Foro Latinoamericano para una nueva justicia”, que se desarrolla en Quito y al que también asistió la senadora chilena Isabel Allende Bussi y la exministra de Educación de ese mismo país Maringen Hornkolh.
“Este es un debate que debemos llevar adelante en América Latina, sin miedo”, dijo Correa, que ha mantenido un permanente pulso con varios medios de información del país, así como con ciertos periodistas que han criticado su gestión.
De acuerdo a EFE, Correa también se refirió al contenido de la consulta popular que promueve desde su Gobierno para reformar el sistema de justicia, al que acusó de ser ineficaz y de estar salpicado de corrupción.
Señaló que su Gobierno, con el apoyo de expertos de Chile y Brasil, ha empezado a trazar una estrategia para ese cambio en la justicia, que espera que el pueblo lo ratifique en la consulta.
El objetivo, dijo, es que se genere la “igualdad de acceso a la justicia” y rechazó el argumento de la oposición, que le acusa de querer tomar el control de la función judicial.
“Invitamos a organismos internacionales a acompañar a Ecuador en este desafío”, dijo el mandatario en el foro, y pidió a Isabel Allende Bussi y Maringen Hornkolh formar parte de una veeduría internacional que vigile el proceso de reforma judicial en su país.
En caso de ganar el plebiscito, dijo Correa, inmediatamente pondrá en marcha la reforma al sistema de justicia, que lo sustanció en cinco ejes.
Correa, sin embargo, no habló de sus intenciones de re-elegirse presidente, ni hizo alusión a que en Chile hoy gobierna un gobierno con un presidente conservador, ni dijo que en Chile el partido de centro izquierda que gobernó después que los militares entregaran el poder, no ha tratado de cambiar el modelo económico del país.
En tanto, Hornkohl de acuerdo a EFE recordó que en Chile, “luego del quiebre democrático”, se ha “vivido un gran proceso de cambios, aunque reconoció que “construir una sociedad de derechos ha sido un norte no ha acabado” todavía.
También destacó la “concertación de partidos por la democracia” que permitieron en su país llevar adelante reformas importantes, lo que generó también un mejor nivel de “confianza de los ciudadanos en las actuaciones del Estado”.
Algo que en Ecuador no ha ocurrido.
I am often asked when I chose to become Catholic. However, it is more truthful to say that over the course of several years I gradually became Catholic and then decided one day to accept the faith I had already come to embrace.
My wife, Callista, is a lifelong Catholic and has been a member of the choir of the Basilica of the National Shrine of the Immaculate Conception in Washington, D.C., for 15 years. Although I was Southern Baptist, I had attended Mass with Callista every Sunday at the basilica to watch her sing with the choir.
I accompanied Callista to Rome in 2005, when the choir was invited to sing at St. Peter’s Basilica. While there, I had the opportunity to talk at length with Msgr. Walter Rossi, rector of the basilica in D.C., about faith, history and many of the cultural challenges, including secularism, facing our country. Our conversations were enlightening and intriguing. During that trip, I experienced my first visit to St. Peter’s Basilica, and I recall marveling at being in the presence of the historic truth of the Church that day. At the same time, I was being influenced by several books I was reading, including George Weigel’s The Cube and the Cathedral, about the crisis of secularism in Europe, and his book The Final Revolution, about the role of Christianity in freeing Eastern Europe from an atheistic dictatorship. I was also moved by Pope Benedict’s reflection in his book Jesus of Nazareth that, “God is the issue: Is he real, reality itself, or isn’t he? Is he good, or do we have to invent the good ourselves?”
Throughout our travels, whether Callista and I were in Costa Rica or Africa, she was adamant about finding a local Mass on Sunday. Listening to “Amazing Grace” being sung in Chinese at Mass in Beijing was a beautiful experience, and worshipping with believers across the world opened my eyes to the diversity and richness of the Catholic Church.
Over the course of a decade, the depth of faith and history contained in the life of the Catholic Church were increasingly apparent to me, and the centrality of the Eucharist in the Catholic Mass became more and more clear.
Pope Benedict XVI’s visit to the United States in April of 2008 was a turning point for me. The Holy Father presided over solemn vespers with the U.S. bishops in the Crypt Church at the basilica in Washington. Callista’s choir was asked to sing for Pope Benedict at vespers, and as a spouse, I had the unique opportunity to attend the papal visit and was deeply moved by the occasion.
Catching a glimpse of Pope Benedict that day, I was struck by the happiness and peacefulness he exuded. The joyful and radiating presence of the Holy Father was a moment of confirmation about the many things I had been thinking and experiencing for several years.
That evening I told Msgr. Rossi I wanted to be received into the Catholic Church, and he agreed to join Callista as my sponsor. Under his tutelage, I studied the Catechism of the Church over the next year and was received into the Church in March of 2009 in a beautiful Mass at St. Joseph’s on Capitol Hill.
After a decade-long — perhaps lifelong — faith journey, I was finally home.
In a priceless formulation in his budget speech two weeks ago, Obama said that Americans look at the poor and say, “There but for the grace of God go I.” And so, in the president’s words, “we contribute to programs like Medicare and Social Security.”
Except we don’t “contribute.” We are compelled under threat of imprisonment to take out a joint checking account with the government. Ask Wesley Snipes what happens when you fail to “contribute” sufficient alms to Uncle Sam. It’s easy to find him: He’s sitting in the McKean Federal Correctional Institution in Pennsylvania.
The downside of Obama’s exponentially expanding government — to the detriment of the private sector — is that it is now impossible for young people to find work.
But there’s also good news! Now there are plenty of government social workers to counsel the unemployed through their depression over not being able to find a job and to process their unemployment checks.
The unholy alliance between unionized government workers and elected Democrats has led to an explosion in taxpayer-funded government employees, who, incidentally, can never be fired.
In the 1980 award-winning PBS series “Free to Choose,” Nobel Prize-winning economist Milton Friedman described the steps required to fire a civil servant:
“In January 1975, a typist in the Environmental Protection Agency was so consistently late for work that her supervisors demanded she be fired. It took 19 months to do it, and this incredible 21-foot-long chart lists the steps that had to be gone through to satisfy all the rules and all the management and union agreements.
“The process involved the girl’s supervisor, his deputy director, his director, his director of personnel operations, the agency’s branch chief, an employee relations specialist, a second employee relations specialist, a special office of investigations and the director of the office of investigations. This veritable telephone directory, need I add, was paid with taxpayers’ money. Who could invent a better protected job than this one — before it came to its end?”
Thirty years later, a civil servant whose poor job performance consisted of only being chronically late would qualify as “Civil Servant of the Year.”
Taking only one performance problem in a single government office — surfing Internet pornography at the Securities and Exchange Commission: In 2010, 31 employees were found to have spent their workdays downloading Internet porn in the 2 1/2 years during and preceding the financial crash that led to the greatest depression in nearly a century. One of their favorite online porn sites was “Fannie Mae Hill,” while those who prefer big girls were at “Too Big to Fail.”
If only Bernie Madoff had posted naked videos of himself on the Internet, the SEC might have noticed him. Seventeen of the porn-surfers were being paid government salaries of $99,356 to $222,418.
One senior lawyer at SEC headquarters in Washington, D.C., admitted to spending eight hours a day looking at Internet pornography. Sometimes he even worked through his lunch hour. He had downloaded so much pornography that his computer was full — at which point he began burning the pornography onto CDs and DVDs, which he stored in boxes in his office.
In another classic example of the left hand not wanting to know what the right hand was doing, an employee with the SEC’s Division of Corporation Finance admitted watching up to five hours a day of pornography in his office. His favorite pornographic websites were bookmarked on his government computer, and he had both downloaded and uploaded pornographic videos to the numerous websites he had joined.
Even after admitting to surfing porn all day on the taxpayers’ dime, not one of the lonely SEC employees was fired, nor were their names released by the government, even in response to a Freedom of Information Act request. (Although most of them were referred for membership in D.C. sex clubs.)
These are the true beneficiaries of big government — or our “commitments,” as Obama calls them — not the poor, the elderly, the disadvantaged, and those about whom we say “There but for the grace of God, go I.”
Democrats don’t resent “the rich” on behalf of the poor. They resent the rich on behalf of the government.
THE PRESIDENT TURNS LEFT
By DICK MORRIS
Published on TheHill.com on April 26, 2011
Two months ago, Washington was abuzz with speculation that Obama was going to follow Bill Clinton’s reelection strategy and move to the center, forsaking the liberal agenda that cost him control of the House in 2010. Now it is evident that he has decided to come down hard left and wage his reelection fight from his liberal bunker, firing shots at Republican cuts in Medicare, pushing tax increases on the rich, and attributing the gas-price increase to speculators.
Very possibly the decision to tack to the left was not entirely voluntary. With the Republicans constantly confronting him with budget cuts and spending reductions, Obama cannot portray himself as a centrist. Every day, he is on the defensive against proposals for Republican attempts to rein in federal outlays. Against a backdrop of repeated confrontation, he cannot move to the middle. Indeed, there is no middle. His budget compromises with Boehner are not middle ground, they are partial surrenders, grudging acceptances of budget cuts he would never otherwise allow.
|In the Clinton days, there were — and I suspect still are — two camps in the Democratic White House. There were those who advocated a fundamental repositioning in the center of our politics and those who wanted to battle along ideological lines, using economic populism and class antagonisms to bolster their chances of victory.The problem with a leftist strategy is that the vote share a Democrat can attract with it has a very low ceiling — in the low 40s. Economic populism just doesn’t play that well outside of the Democratic left.
The key to this electoral model is, of course, turnout. Obama made it work in 2008 by adding the votes of new, younger voters, increasing the African-American and Latino turnout and playing on the unique economic panic of the times. But, absent a big increase in liberal turnout, the appeal of class warfare and populist rhetoric is sharply limited.
Will Obama be able to replicate his turnout model of 2008 in 2012? With high unemployment, inflation and gas prices, it’s very unlikely. His problem, more probably, will be to animate his base and breathe it back to sufficient life to give him any chance at all. Most polls show growing liberal disaffection with Obama, as Libya, Afghanistan and his failure to close Guantánamo sap the enthusiasm he needs on the left.
But Obama has a larger problem in moving to the left. You can’t get reelected president as an advocate. You need to be a leader. Only Harry Truman managed to get a second term by way of overtly partisan rhetoric, and he was coming off 20 years of the New Deal coalition. A president who attacks the rich and seeks to divide the country might be able to rely on the base to keep his approval ratings in the low 40s, but he has no way to get reelected.
Indeed, Obama will lose in 2012 for reasons very different from his victory in 2008. By the time the next election comes around, voters will see all around them evidence of his weakness and incompetence. It is now evident in the escape of Taliban prisoners in Afghanistan. It will increasingly be clear as inflation mounts and gas prices continue their upward progression. More and more it will be evident that this former community organizer is not up to the job and has no idea what he is doing.
A positioning on the left might suffice for winning the Democratic nomination or even election to an open seat. But it does not satisfy the national need for leadership, ability, skill and wisdom. Obama cannot be reelected in running like the candidate of 2008.
Why Republicans Will Never Win the PR Battle on a Government Shutdown. And Why They Shouldn’t Care. | RedState | Erick Erickson
Conservatives are prone to lament a liberal bias in the media. There is another bias conservatives should play more careful attention to because it affects even the more relatively unbiased analysts and reporters that exist on television, radio, and in print. It is the “good government” bias.
The good government bias’s hallmark is the exasperated sigh of the Washington press corps longing for the “adults” to have an “adult conversation” and handle gridlocked issues in Washington as “adults in the room.” In other words, principles be damned, we need government to work. This is perhaps the most common press bias because it chooses to ignore or downplay real principled concerns in favor of practical, pragmatic, or “adult” solutions.
Republicans in Washington are scrambling trying to find a plan to stave off a government shutdown and reduct the debt to GDP ratio while looking like “adults” to placate a critical press. It won’t happen. The GOP is so fearful of a government shutdown and the media’s spin that the Democrats will be able to cajole them into doing less than they should.https://jamespatrick1.wordpress.com/wp-admin/post.php?post=6256&action=edit
One of the ideas making the rounds is Senator Bob Corker’s CrAP Act. The CrAP Act would restrain government growth at 23% of GDP, which is higher than historic norms even into the Bush Administration. Corker, through accounting sleight of hand, says it is really 20% of GDP, but that, like his Act, is crap.
It is, however, all done in the name of good government and bipartisanship in an effort to slow the growth of government without a government shutdown. Republicans need to understand that they will never ever win a PR battle on a government shutdown with the media, but they shouldn’t fear that. Winning a PR battle with the media is no longer necessary to win the hearts and minds of the American public.
But to understand why the GOP won’t win a PR battle is to understand how the Washington press works and is to understand precisely why the GOP so often comes off as the stupid party selling its soul for larger government.
One of the old sayings in Washington is that there are two parties — the stupid party and the evil party. Occasionally the stupid party and evil party will get together and do something that is both stupid and evil and it will be hailed as a bipartisan compromise. The media is complicit in this because just about every bipartisan compromise gets referred to as the adults coming together in a room.
The most recent conversation about the 2011 continuing resolution is a case in point. Analysts and reporters talked about the “far right” and the “far left” and how John Boehner and Barack Obama would have to overcome those extremes to find a bipartisan solution. The simpleness of the conversation ignored the very real concerns by both liberals and conservatives related to spending priorities and the size of government.
More troubling for conservatives, good government rarely, if ever, can also be limited government. Despite the federal constitution being a constitution of limit power for Washington, the nation has evolved to consider Washington the center of power. It is reflected in a class of political analyst and reporter in Washington who believes themselves to be covering the corridors of power. The conversation rarely occurs among the press corps that perhaps Washington should not be doing something or its power to act is limited. The very notion is silly in the twenty-first century despite what the Constitution may or may not say.
Consequently, instead of treating the concerns of those who want more limited government seriously, they are assigned the label of “far right” and definitionally excluded when mentioning “adults” having conversations to fix Washington. Should Washington’s power diminish, reporters’ access to power would diminish. Smaller government is a deal breaker for the Washington press corps.
This should not, however, matter to Republicans. A recent CBS News survey found that 70% of Americans oppose raising the debt ceiling even if it means higher interest rates. The vast majority of Republicans and Independent voters oppose raising the debt ceiling. Surprisingly, just under half of Democrats oppose raising the debt ceiling too. Meanwhile, any casual review of reporting on the debt ceiling will find that all the adults think the debt ceiling needs to be raised.
In essence, the media and the Democrats are both stuck in 1995 when the GOP lost the PR battle to a media highlighting boy scouts shut out of the National Air and Space Museum. But the public has moved on to recognize the problem. Likewise, the public’s trust of the media continues to fall to new lows.
The GOP should not be afraid of the media’s spin and bias on this because the public has largely tuned out the routine pooh-poohing and pining for adults by the media. Instead of worrying about PR, the GOP should worry about reducing the size and scope of the federal government, which more and more polls show Americans want.
Deben abrirle espacio en el museo de cosas increíbles de Ripley.
En Alaska fue durante muchos años un policía ejemplar salvo por un pequeño detalle; no era ciudadano estadunidense.
Su verdadero nombre es Rafael Mora López y tiene 47 años. Es mexicano y por años fue policía en Alaska usando el nombre de Rafael Espinoza.
De acuerdo a las autoridades locales López fue detenido la semana pasada cuando funcionarios norteamericanos se dieron cuenta que habían dos Rafael Espinoza tramitando un pasaporte estadounidense a la vez. El verdadero Rafael Espinoza, que tiene doble ciudadanía y vive fuera de Estados Unidos y López, quien había usurpado su identidad.
El jefe de la policía de Anchorage, Mark Mew fue el que dio la noticia y explicó el caso a los periodistas.
A López lo descubrieron por casualidad cuando renovaba el pasaporte falso de Espinoza, a la vez que este hacía lo mismo en el extranjero.
Cuando los agentes federales que procesaban su solicitud descubrieron el presunto fraude arrestaron al policía modelo. Mora López se declaró inocente de la acusación federal de fraude con pasaporte, que lleva la pena máxima de 10 años de prisión.
Mew precisó que el hombre cuya identidad fue suplantada por Mora López es una persona real, pero que no tenía “ningún registro en Estados Unidos salvo el hecho de que existía”.
El jefe de la policía le dijo a la Associated Press que Mora López renunció al departamento de policía, donde trabajó durante seis años. Dijo que había sido un agente de buena reputación que había sido premiado porque, junto con otro policía, le aplicó resucitación cardiopulmonar a una persona el año pasado.
El jefe policial dijo también que Mora López estaba por recibir un reconocimiento por colaborar con las autoridades en el rescate de una persona con una pierna fracturada en las peligrosas marismas de Anchorage.
De acuerdo a la AP, una orden federal de liberación con fecha del martes refirió que Mora López pagó una fianza de 50.000 dólares y aceptó el seguimiento electrónico a condición de librar la cárcel. El viernes fue condenado a arresto domiciliario.